Stocking/Paying for Naloxone & Billing

PrescribeToPrevent.org does not receive funds or other support from any manufacturer of any component of naloxone rescue kits, nor does PrescribeToPrevent.org endorse specific products. We mention manufacturers only to facilitate access. To our knowledge, we mention all sources of the components of naloxone rescue kits.

Billing

Some insurance plans, including Medicaid and Medicare in some states, reimburse for naloxone. Compiling a list of insurance plans in your area that will cover naloxone and collaborating with a pharmacist will be helpful. Because naloxone is not an expensive medication, even patients whose insurance will not cover the medicine may be willing to pay for naloxone.

Advocates in some locations have been successful in persuading insurers to cover the cost of naloxone or have it added to local ADAP (AIDS Drug Assistance Program) formularies.

Stocking the materials*

Naloxone:

0.4/mL naloxone for IM injection is available in two forms from Hospira (NDC 0409-1219-01 for 10mL multidose vial and NDC 00409-1215-01 for 1mL single dose vial)

2mg/2mL naloxone is available from IMS/Amphastar (NDC 76329-3369-1). This is the concentration that is used for IN administration. While naloxone is not approved for intranasal administration by the FDA, it is the standard of care in many areas because it is a needleless alternative. CLICK HERE for a randomized controlled trial of IM naloxone vs IN naloxone.

For nasally administered naloxone – the mucosal atomization device (MAD-Nasal) from LMA North America fits onto the luer-lock of the IMS/Amphastar naloxone

*It may be most convenient to encourage patients to have their prescriptions filled at a pharmacy with which prescribers have had conversations about logistics and accessing supplies. This will ensure that patients can fill prescriptions without special ordering the materials.

Naloxone formulation & packaging

Pain patients receive increasingly complex pharmaceutical regimens that may be concurrently managed by multiple health care providers. In addition to screening tools for misuse or addiction, drug testing, and contracts, consider prescribing naloxone for any patient that meets the suggested inclusion criteria for a naloxone rescue kit. Check out Project Lazarus’ innovative community based pilot project to prevent overdose among pain patients. Universal application of the inclusion criteria is a way to explain to patients who may not believe themselves to be at risk for accidental overdose.

Emergency Medicine:

Several emergency departments (EDs) have implemented a policy that patients presenting with opioid poisoning should receive an overdose prevention kit upon discharge. EDs that operate Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs have also incorporated overdose education and naloxone rescue kits as a brief intervention, which may be billable service in pilot EDs. CLICK HERE for an SBIRT guidance document, including information on billing. According to the SASSI Institute, major insurers covering screening and brief intervention include the Federal Employee Health Benefits Program (Whyche, 2008) and the following private plans: Aetna (nationwide), CIGNA (nationwide), Anthem Blue Cross and Blue Shield (Colorado, Connecticut, Indiana, Kentucky, Ohio, Maine, Missouri, Nevada, New Hampshire, Virginia, and Wisconsin), Blue Cross of California, Blue Cross-Blue Shield in Georgia, Blue Cross-Blue Shield of Minnesota, Empire Blue Cross-Blue Shield in New York, and Independence Blue Cross HealthPlus (Michigan).

Addiction Treatment:

Addiction treatment clinicians are in a position to provide overdose prevention and naloxone rescue kits to a uniquely vulnerable patient population – the newly abstinent at risk of relapse. If patients do not relapse, they will not be at risk for accidental overdose themselves, but they will interact with others in their social network who are at high risk CLICK HERE for a brief overview of barriers and strategies for enacting overdose prevention and naloxone rescue kits in substance abuse treatment environments.